7 babies isn't lucky, some doctors say Septuple pregnancy leads to debate among fertility experts

November 06, 1997|By Ken Fuson | Ken Fuson,SUN STAFF

CARLISLE, Iowa -- While this small town eagerly awaits the birth of septuplets, fertility experts are debating whether such a rare and high-risk pregnancy could have -- or should have -- been prevented.

"Really, these things should not happen," said Dr. Fady Sharara, assistant professor of a fertilization program at the University of Maryland School of Medicine in Baltimore. "That's not a success. That's a failure in our book."

Other doctors say the Iowa case illustrates the complications that can result when couples desperate for children rely on fertility drugs to improve their chances. Controlling the number of babies is an inexact science, they say.

Bobbi McCaughey, 29, is approaching her 29th week of pregnancy with seven fetuses -- an event notable for the number and the length of time she has carried them.

McCaughey (pronounced McCoy) has been on bed rest since Oct. 15 at Iowa Methodist Medical Center in Des Moines. Doctors say they will perform a Caesarean section if there is any change in the fetuses' condition or McCaughey's.

Doctors say the longer the fetuses remain in the womb, the better their chances for survival.

There are no known cases of surviving sets of septuplets, and hospital officials have stressed the dangers of multiple births.

'High-risk pregnancy'

"Please remember that this is a high-risk pregnancy," said Dr. David Alexander, medical director of Blank Children's Hospital, a branch of the Des Moines hospital.

For doctors who specialize in reproductive medicine, the issue is controlling the number of eggs that are fertilized. Some say there are enough safeguards to prevent seven pregnancies; others say there are no guarantees.

"I have a hard time viewing this as a technological advance," said Dr. Carl Weiner, director of the Center for Advanced Fetal Care at the University of Maryland School of Medicine.

By contrast, Dr. Brad Van Voorhis, an associate professor at the University of Iowa who specializes in reproductive medicine, said multiple births are a known risk factor in prescribing fertility drugs to women. "I don't want to point any fingers," he said. "I could be in the same boat in a few weeks. You never know."

McCaughey and her husband, Kenny, 27, a billing clerk for an automobile dealership, live in Carlisle, a town of 3,500 people near Des Moines. The couple and their doctors have declined to be interviewed since word about the pregnancy broke last week.

Before then, Kenny McCaughey said his wife took fertility drugs because they experienced trouble conceiving their only child, daughter Mikayla, now nearly 2.

Dr. Donald Young is one of two reproductive endocrinologists in the Des Moines area. Endocrinology is a sub-specialty of obstetrics and gynecology that concentrates on fertility, contraception and hormonal disorders.

Young said he did not treat Bobbi McCaughey. The other endocrinologist in Des Moines, Dr. Katherine Hauser, has declined to comment.

'Selective reduction'

Young has supervised two cases in the past year in which women who took fertility drugs became pregnant with seven fetuses. Each time, the couple chose what's called "selective reduction," reducing the number of fetuses, usually to twins or triplets, to increase the survival odds for the others.

Kenny McCaughey has said he and his wife rejected that option. "God gave us those kids," he said. "He wants us to raise them." Friends describe the couple as deeply religious.

Doctors say the two most popular forms of increasing fertility are drugs and in-vitro fertilization.

In the first method, hormones are injected into a woman to stimulate the production of eggs. When enough eggs are produced, another drug is given to trigger ovulation.

Weiner said doctors can monitor estrogen levels and the size of the follicles that contain the eggs to determine if too many eggs are being produced.

"You don't want to stimulate too many," he said. Allowing seven eggs to become fertilized "is not good therapy," he added. "They should have known that. They should have pulled back."

"You want to prevent them from getting much more than triplets," Weiner said. "It's very, very unusual to get quadruplets and you don't want septuplets."

Controlling the eggs

Young, the Des Moines doctor, said controlling the number of eggs is more complex than simply shutting a valve. For one thing, the use of ultrasound is not always precise. For another, "you can't predict how each individual is going to react."

Young said one woman in his care showed 66 eggs on the ultrasound image, but she did not get pregnant. "It's a tragedy when this happens," he said of multiple pregnancies. "But it's one of the risks."

In some cases, Young said, the cost of fertility drugs -- about $2,000 a cycle -- and the desire to have children prompts couples to proceed even with the risk of multiple births.

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